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Dominguez-Rojas JÁ, Vásquez-Hoyos P, Pérez-Morales R, Monsalve-Quintero AM, Mora-Robles L, Diaz-Diaz A, Torres SF, Castro-Dajer Á, Cabanillas-Burgos LY, Aguilera-Avendaño V, Cantillano-Quintero EM, Camporesi A, Agulnik A, Mukkada S, Alvarado-Gamarra G, Rojas-Soto N, Mendieta-Zevallos AL, Tello-Pezo MV, Vásquez-Ponce L, Lasso-Palomino RE, Pérez-Arroyave MC, Trujillo-Honeysberg M, Mesa-Monsalve JG, Pardo González CA, López Cubillos JF, Gonzalez-Dambrauskas S, Coronado-Munoz A. Association of Cancer Diagnosis and Therapeutic Stage With Mortality in Pediatric Patients With COVID-19, Prospective Multicenter Cohort Study From Latin America. Front Pediatr 2022; 10:885633. [PMID: 35592840 PMCID: PMC9110860 DOI: 10.3389/fped.2022.885633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Children with cancer are at risk of critical disease and mortality from COVID-19 infection. In this study, we describe the clinical characteristics of pediatric patients with cancer and COVID-19 from multiple Latin American centers and risk factors associated with mortality in this population. Methods This study is a multicenter, prospective cohort study conducted at 12 hospitals from 6 Latin American countries (Argentina, Bolivia, Colombia, Ecuador, Honduras and Peru) from April to November 2021. Patients younger than 14 years of age that had an oncological diagnosis and COVID-19 or multisystemic inflammatory syndrome in children (MIS-C) who were treated in the inpatient setting were included. The primary exposure was the diagnosis and treatment status, and the primary outcome was mortality. We defined "new diagnosis" as patients with no previous diagnosis of cancer, "established diagnosis" as patients with cancer and ongoing treatment and "relapse" as patients with cancer and ongoing treatment that had a prior cancer-free period. A frequentist analysis was performed including a multivariate logistic regression for mortality. Results Two hundred and ten patients were included in the study; 30 (14%) died during the study period and 67% of patients who died were admitted to critical care. Demographics were similar in survivors and non-survivors. Patients with low weight for age (<-2SD) had higher mortality (28 vs. 3%, p = 0.019). There was statistically significant difference of mortality between patients with new diagnosis (36.7%), established diagnosis (1.4%) and relapse (60%), (p <0.001). Most patients had hematological cancers (69%) and they had higher mortality (18%) compared to solid tumors (6%, p= 0.032). Patients with concomitant bacterial infections had higher mortality (40%, p = 0.001). MIS-C, respiratory distress, cardiovascular symptoms, altered mental status and acute kidney injury on admission were associated with higher mortality. Acidosis, hypoxemia, lymphocytosis, severe neutropenia, anemia and thrombocytopenia on admission were also associated with mortality. A multivariate logistic regression showed risk factors associated with mortality: concomitant bacterial infection OR 3 95%CI (1.1-8.5), respiratory symptoms OR 5.7 95%CI (1.7-19.4), cardiovascular OR 5.2 95%CI (1.2-14.2), new cancer diagnosis OR 12 95%CI (1.3-102) and relapse OR 25 95%CI (2.9-214). Conclusion Our study shows that pediatric patients with new onset diagnosis of cancer and patients with relapse have higher odds of all-cause mortality in the setting of COVID-19. This information would help develop an early identification of patients with cancer and COVID-19 with higher risk of mortality.
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Affiliation(s)
- Jesus Ángel Dominguez-Rojas
- Pediatric Critical Care, Hospital Edgardo Rebagliati Martins, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Lima, Peru
| | - Pablo Vásquez-Hoyos
- Pediatric Critical Care, Hospital de San Jose, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Bogota, Colombia
- Research Division, Department of Pediatrics, Fundacion Universitatia de Ciencias de la Salud–FUCS, Bogota, Colombia
| | - Rodrigo Pérez-Morales
- Pediatric Critical Care, HOMI Fundacion Hospital Pediatrico La Misericordia, Bogota, Colombia
| | | | | | - Alejandro Diaz-Diaz
- Pediatric Infectious Diseases, Hospital Pablo Tobon Uribe y Hospital General de Medellin, Medellin, Colombia
| | - Silvio Fabio Torres
- Pediatric Critical Care, Hospital Universitario Austral Pilar, Buenos Aires, Argentina
| | | | | | | | | | - Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sheena Mukkada
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Giancarlo Alvarado-Gamarra
- Pediatrics, Hospital Edgardo Rebagliati Martins, Lima, Peru
- Instituto de Investigación Nutricional, Lima, Perú
| | | | | | | | - Liliana Vásquez-Ponce
- Research Center “Medicina de Precisión, ” Facultad de Medicina, Universidad de San Martín de Porres, Lima, Perú
| | | | | | | | | | | | | | - Sebastián Gonzalez-Dambrauskas
- Specialized Pediatric Critical Care (CIPe), Casa de Galicia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Medical School, Pediatric Critical Care, Pereira Rossell Medical Center (UCIN-CHPR), Universidad de la República, Montevideo, Uruguay
| | - Alvaro Coronado-Munoz
- Pediatric Critical Care Division, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, United States
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Nguyen TL, Lam WM, Orr H, Gulbis B, Mauricio R, Tom E, Modem VM, Coronado-Munoz A. Clonidine for the Treatment of Agitation After Dexmedetomidine Discontinuation in Pediatric Patients: A Retrospective Cohort Study. J Pediatr Pharmacol Ther 2021; 26:821-827. [PMID: 34790072 DOI: 10.5863/1551-6776-26.8.821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/02/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Dexmedetomidine has become a widely used drug in PICUs for sedation. We aim to determine the effects of clonidine on pediatric patients after dexmedetomidine use. METHODS This was a retrospective cohort study that evaluated all pediatric patients admitted to a tertiary PICU who received dexmedetomidine infusion for >48 hours. Outcomes in patients exposed to clonidine (CLON) were compared with those of patients who were not exposed (NoCLON). RESULTS A total of 216 patients were included in this study (43 CLON and 173 NoCLON). The primary outcome, agitation, was less in the CLON cohort (9.3%) than in the NoCLON cohort (9.3% versus 29.5%, respectively; p < 0.01). Hospital LOS was longer in the CLON group (59 versus 20 days, p < 0.01), as was PICU LOS (37.4 versus 11.1 days, p < 0.01). There was no significant difference in the occurrence of increased heart rate or blood pressure between the 2 cohorts. Patients exposed to concurrent midazolam and opioid infusions had higher incidence of agitation when they did not receive clonidine (CLON 8% versus NoCLON 37%, OR 0.15; 95% CI, 0.05-0.51; p < 0.01). In contrast, there was no difference in the incidence of agitation for the CLON group versus the NoCLON group when dexmedetomidine was administered alone (25% versus 19%, OR 1.4; p = 0.99). CONCLUSIONS Our study confirms the importance and effectiveness of clonidine to treat agitation after dexmedetomidine discontinuation. A validated withdrawal scoring tool can help better define dexmedetomidine withdrawal in pediatric patients.
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